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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STocKroN CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />(9O '1 0 AJ b.pe. ‘ictokte JOB ADDRESS <br />CROSS STREET CXeL. OW% APN ('01- I co - PARCEL SIZE CI' (0 tit. <br />STC. CITY/STATE/ZIP OWNER ADDRESS i-115- C WIZ GE C-1- • <br />OWNER NAME --r-OttEct. 04-r<711-"(2. <br />13 gE Ad-Two-a '14-S-13 <br />PHONE (626) 0- ZS-qi <br />CONTRACTOR LAM 0 elVg- at"..00AJV I ON rkleiuTteAL-- PHONE 3u,'1-03 -7S- <br />CONTRACTOR ADDRESS 1401 1,4-) • AK. 57. orasTATeizip t-c1C)I, C 9S-2-4 <br />LICENSE 011C-42 UC-36 OTHER CL& NUMBER C EXPIRATION DATE 44 3 0- 22— <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: 0 NEW INSTALLATION <br />LI REPLACEMENT <br />REPAIR/ADDMON <br />0 our-OF-SERVICE SEPTIC SYSTEM <br />0 ENGINEER DESIGNED/ALTERNATIVE <br />0 DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: C RESIDENCE 0 COMMERCIAL <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />0 <br />0 <br />0 <br />SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES 1.11 LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 DISPOSAL PONDS Worm ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMU4J HOUR ADMANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CAL!. (209)953-7697 <br />TITLE AA Cs le DATE 5-2-1- 2 I <br />PERC TEST # 1 <br />SIGNED <br />il I <br />111116161 <br />i <br />11111111111111111111111111111 MEMMEMMOMMEMEMMEMEm immommanommommimmommummommommommulkai <br />1111111111111111111111111111111111111111M immommilimmmommummummummuwammommoppiumw. iiiiiiiiiiiiiilliRipiiiiiiiiiiiiiiiiikipp <br />DEPARTMENT y SE/ONLY <br /> <br /> Date ,t/. / Area LI JI c1 <br /> <br /> Date 0 SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />tCgc.1487) <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />Li)d, s'a 3 UV- (51-1--T -2--i 1 i c..2 5 2e ' y?' <br />Application Accepted By <br />Final Inspection By <br />Employee ID# rJ A <br />Il/Eb <br />2021 <br />_ <br />4/Z/vr <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18